Healthcare Provider Details

I. General information

NPI: 1902809742
Provider Name (Legal Business Name): ABDUL QADIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ABDUL QADIR MD.

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 S NEW RD
PLEASANTVILLE NJ
08232-3730
US

IV. Provider business mailing address

1004 S NEW RD
PLEASANTVILLE NJ
08232-3730
US

V. Phone/Fax

Practice location:
  • Phone: 609-652-4141
  • Fax: 609-652-9939
Mailing address:
  • Phone: 609-652-4141
  • Fax: 609-652-9939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA64342
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: